Friday, August 10, 2012

My wife suffers from chronic migraines. Over the years, she has worked with a number of doctors to choose medication and diet routines to address the problem. None of it has worked very well. This morning, we met with a renowned and clearly very competent neurologist with whom we've worked before. He carefully reviewed past efforts and asked her how the latest suggestions had been working out. Upon hearing that we still do not have a solution, he listed possible options for moving forward, noting the potential side effects of each and carefully hedging about how well we can expect any one approach to work. We chose an option. I then had the following conversation with him.

Me: So would you say that headache treatment is at the research frontier?Doc: I'm not sure I would say that.Me: It seems like the approach is largely trial and error. Is the problem that this is a complicated phenomenon, and we just don't understand it very well?Doc: No. It's not complicated. It's just that different things work for different people, and it takes time to figure out the right combination.Me: And we don't have a reliable way to know in advance what will work.Doc: Yeah.Me: Do a lot of people end up finding something that works? [I wish I'd been more precise with this question]Doc: A lot of people do. [I wish he'd been more precise with this answer]

So we know that different things work for different people, but we really don't know what are the observable predictors of what will work for a certain person. That sounds like the research frontier to me.

I was also intrigued by his unwillingness to simply say, "It's complicated, and as a profession we really don't know much about it." I tried to give him an out so he could say that at low cost. He didn't take it.

This is interesting to me because I think the public has an exaggerated sense of what doctors really know and what they can accomplish. And, as we recently learned, the public also has unrealistic expectations for what the discipline of economics can tell us, particularly in the realm of prediction but also when trying to diagnose problems and prescribe remedies. Both our diagnoses and our prescriptions have large standard errors--they are constructed with considerable uncertainty. In both cases, the public often become disillusioned when they see evidence of non-omniscience. I wonder how much the professions themselves are to blame.

I simply don't expect doctors to know everything. I am completely confident that they know far more than I do about medical issues, so I don't know why they're so hesitant to show me the frontier of their knowledge. I would be a better consumer of medical services if I had a better idea of where the frontier is. It wouldn't make me trust doctors less--it may even make me trust them more. Likewise, I'm confident that, in general, economists typically know more about economics than anyone else, but they don't know everything. Could we have prevented the recent widespread public disillusionment with economists if we were better at managing expectations?

I would add that economists have the added difficulty of doing their work in the middle of highly political issues.